| Klumpke's paralysis | Erb's palsy |
| ------------------------------------------------------------------------------------ | ----------- |
| C8 / T1 lesion | |
| Claw hand due to unopposed action of long flexors and extensors | |
| Can have associated Horner's Xn (C8,T1 are in close proximity to sympathetic chain). | |
| Damage to one can cause damage to the other. | |
| Seen in breech delivery. (upward traction on arm) | |
| Loss of function of lubricals and wrist flexors | |
| Lumbricals flex the MCP joints and extend the PIP and DIP joints; | |
| In KP, there is | |
Causes of diabetes insipidus
| Central | Nephrogenic |
|---|---|
| Intracranial SOL / pituitary surgery / trauma etc | Lithium |
| Infiltrative diseases: Histiocytosis, Sarcoidosis, (but ?not amy_loidosis) | ⬆Ca, ⬇K |
| Haemochromatosis | Demecloclycline |
| DIDMOAD (ada Wolfram Syndrome) | Inherited: Common- ADH receptor mutation Rare: aquaporin 2 mutation |
- Right side to right side. Left to left.
- fibers from superior half travel superiorly (parietal lobe) , fibers from inferior half travel inferiorly (temporal lobe)
Lateral views showing the optic radiations:
[!INFO] Relevant cerebral lobes
Mnemonic: PITS ->
- Parietal lobe lesions -> inferior visual loss
- Temporal lobe lesions -> superior visual loss.
- Retrolenticular - inferior visual quadrants - In the parietal lobe
- sublenticular - superior visual quadrants - In the Temporal lobe.
| Characteristic | EDH-epidural/ extradural | SDH-subdural |
|---|---|---|
| Patient | Young, Hx of trauma | Old |
| Aetiology | Usually trauma, spontaneous is very rare | Commonest is traumatic, cerebral atrophy (old age, chronic alcohol use) is a major risk factor |
| - | Tamponade effect will control rate of bleeding (as it’s venous) | |
| Type of bleed | 80% arterial, therefore rapid | Mostly venous / small arteries |
| Site | Commonly middle meningeal artery at [[foramen spinosum.png]] | Bridging vein or other sites |
| Plane | Potential space between dura and skull | Between dura and arachnoid |
| Presentation | Lucid interval → rapid decrease | Can be acute or chronic. |
| Imaging | Lens shaped, does not cross suture lines, crosses dural attachments | Crescent shaped, crosses suture lines, does not cross dural attachments |
| - | Chronic changes occur: Encapsulation and resorption / hygroma formation | |
| Also seen in trauma | most common type seen in trauma | |
| Lower impact, lucid interval present | Caused by Higher energy impacts - patient won't regain consciousness | |
| brief, linear contact force to the skull. | Can Occur in less severe trauma (antigoagulants, old age are RF) | |
| Arterial or venous. (commonest site = middle meningeal artery); caused by disruption of vessels secondary to dura separating from skull. |
Mechanism: tearing of veins due to relative movement of brain due to acceleration | |
| rare in age > 60 as 'dura is tightly adherent to the skull' | highest incidence in 40s to 70s. | |
| most are acute. | Can be acute or chronic | |
| Source |
OR
Wernicke = Word Salad. (W - W)
| Wernicke's | Brocas | Conduction aphasia | Global aphasia |
|---|---|---|---|
| Receptive | Expressive | ||
| Fluent | Non fluent | ||
| "Word salad" | "Tip of the tongue" | Speech fluent; repetition poor; comprehension preserved. |
All of the above; can communicate with guestures |
| Superior temporal gyrus | Inferior frontal gyrus | Arcuate fasciculus | All regions affected |
| Middle Cerebral artery | Middle cerebral artery |
[!TIP] Mnemonic: The parietal lobe is responsible for interpretation of "things in space";
Symbols lose meaning - agraphia, acalculia, alexia,
Disorientation
Spatial structure of tactile stimuli is lost - "cortical sensory loss"
Astereognosis
[!TIP] Mnemonic:
The temporal lobe seems to be involved in
- processing and interpretation of sensory stimuli
- predominantly auditory, also visual, smell etc.
- Emotional regulation
- Memory
Functions:
Features of temporal lobe dysfunction:
| Function | Dysfunction |
|---|---|
| facial recognition | prosopagnosia - inability to identify faces |
| Language comprehension | Wernicke aphasia |
| Processing visual stimuli | Visual agnosia |
| Processing sound | Sensoryneural hearing loss, word deafness, difficulty in interpreting sounds |
| Attention | problems paying attention amidst other stimuli <-? difficulty in filtering out sensory stimuli? |
| Disrupted sensory processing during TLE | Temporal lobe epilepsy: not significant motor component as TL isn't involved in motor function. Features include déjà vu, unprovoked fear, visual distortions, and strange tastes and smells. |
| Memory | Inability to form new long term memories or if severe, loss of previous long term memories associated with self identity -> which can lead to personality change |
| Source |
Causes of QT prolongation:
| Congenital | Drugs | Other |
|---|---|---|
| - Jervell-Lange-Nielsen syndrome (includes deafness and is due to an abnormal potassium channel) - Romano-Ward syndrome (no deafness) |
- amiodarone, sotalol, class 1a antiarrhythmic drugs - tricyclic antidepressants, fluoxetine - chloroquine - terfenadine - erythromycin |
- electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia - acute myocardial infarction - myocarditis - hypothermia - subarachnoid haemorrhage |
The classic description of the left cardiac ventricle is as containing two papillary muscles: the anterolateral and posteromedial.[2] The anterolateral arises from the sternocostal wall, and the posteromedial papillary muscle arises from the diaphragmatic wall of the ventricle. The right ventricle contains three papillary muscles, classically described as anterior, posterior, and septal. Source
Left anterolateral papillary muscles derives from branches of the left coronary artery. The blood supply to the left posteromedial papillary muscles most commonly derives from the right coronary artery Source
[!INFO] Azithromycin
used as last resort add on therapy
Reduces exacerbation frequency but promotes antibiotic resistance.
Pathologic findings in pulmonary arterial hypertension:
Treatment:
Two groups: